rc Ls) OLDMUTUAL ina NEW ZERO INTEREST LOAN/ Stsi6[stols [ale DISINVESTMENT AND PLAN/ Investment Pan uber Savings Bent amber SAVINGS BENEFIT tl tfe[x|ijnvlf[4 CANCELLATION FORM (eo comutnn 7 |o| 5| 4 17/4 (MAX INVESTMENTS/INVESTMENT HORIZONS/GREENLIGHT SAVINGS) a ase er neste mae eae ‘The submitting party must please fax the completed application form to IMED: (08600046 34 or (High Value: 0860121133) ‘This application orm hasbeen checked for completeness ana accuracy Lonel G. Fisher Telephone number 021 691-0303, Emalessres —_llonel@fisherconsulting.acza IMPORTANT NOTES: inthis document 1" the singer ormot word icles the pha and vice verse *retorenees te persensinhude individuals jure persons, partnerships and anyother body of persons lente complete in BLOCK LETTERS an fa to MED 0860 0046 240 gh Vue: 086012138) 1 If acuity ceston ha Deon recorded in rept ofthis Plan/Sasings Benet, your request fr zero intaes ln, pall snvestment a Pan/ ‘Sungs Benet cancllaten can only be pocesied fe rceve lta om te Cessonsy ging us parson to proceed or ring a the 2. Please attach proof of identity. 3.) Prcetor banking details is required feg a cancelled + wsed cheque) 44. FCA documents lg. ro of identity FICA Addenda FICA Declaration uty bil te equtedin the event of lan/dswesIment or lanavings Benet cancellation withn 3 years of inception os pac nerpec of which te anual otal of ecuing premiums paid docs pt excsedR2S 000 for esingle premium payable does ret exceed 50.000 5. [> Shoutsene contacting Partybeacompany.a eter Author rome any cortiming who may slgnenbshal ofthe entyierequive Theleter © |__ tree contacting Pry ira tus eolton signet by All the tustos requires 11. failure to comely with he above eutements may atthe dacetion of! Mutual fe Assurance Compary South Aca Limited o Old Mutualimestment er vces Py reserves the Hah Ye ein for 8 specie period. ary PLEASE TICK ONE RELEVANT BLOCK FOR REQUESTED TRANSACTION (7) rer snvestment- You il corte paying premiums nyu n/n vet -Fullolinvectment and Cancellation ot lan/Savings Benet -You wil no longerpsyptemums on your Flan/ Sng: Senet tne Smings Benefit cancestionzelecte. the Savings Genet premium il be ancl! The GREENLICHT Rsk Benet wi ti conten PLEASE TICK THs BLOCK IF YOU WOULD LIKE THE REQUESTED TRANSACTIONrc ‘SECTION DETAILS OF CONTRACTING PARTY We: ro melv) ms] | cnn vowias [DLA surname) elslalul T T ee DEBORAH \LONETTA ANNELINE fegutetonnomber” 6 44,0109 0/2/16 0187) errr aate | Paseprt number | twneteno South Atnean iD numbers mai) batten oero1eles moneiwnmse (4 4|6 8] 4|7|6) 1] 416 amyontashsttanretéeet wef] _ 10] evtsosoes (3) 1U/N| 1 €| |8|T|R/E/E|T BELLVILLE souTiM reutene|?|6|8]0 oe SAME AS ABOVE | Foe cousciromen wo coe 0] 2] 4] | |} mal 4]2]s]0]0[6]0 amet cote O24 wio|s/t/2/s/21s catprowrne[0 6 |1/8[5]4]1] 0] 1] 8 estates d/e|8/8|1 €lel@jtie Ht vicla|Rie|. 0|R/G SECTION ZERO INTEREST LOAN (LIFE: PURE INVESTMENT ONLY) + Thereby apply to Olt Mutual ora Ze Interest Loan | understand that ite 8 pre-anaiten ofthe lean tht Latch an meunt equal tthe loon arroune 22 + hereby instruct Cl Mutual to sth an arnount equal to the eslasle Rend vale f the units ram the investment una o Iunderctand that wil not earnany growth the funde that ae switched tthe Capita Secured Fund Netethat te actual and ameunt ofthe loan may net be exactly equal tothe amount requested due te dally fuctationsin the unit price shoud debit order or stop order in operation be canceled? Ut-verenot selected, we wllcontnuetocollet premiums) Fora Reguar Premium investment Plan/Commtted Investment Pan alan Amendment Charge/Reduction Fee willbe deducted rm the fund vale. For 1 Fecussed iwestment Plana reduction fos and Tanaaelon Admin Fe llbe desucted tam he fund al For Flexible Pane (tr) reduction fe willbe deducted fromthe fundalueifZoreIntrect Loan ie made within the fst year ofthe plan LUnTATION OF LoaN AMOUNT Tndrtane tat the arneunt of te ln may be ited a rat ofthe Acencum tomy Sang Benoit CREENLICHT ony In cerain cumstances the regulations pomulgsted under S54 ofthe Lng term insures Ac imi the amount hat Old Mutu may loan fo ou. The ean trun wilemereore be ime te les ot, 'yithecantacting Pres erate ha not been saquesiatediuldatd nd ‘he Planing Boel az not Deon cede pledged to snyors pte 16 6/60 7/4|2r LOANTERMS AND CONDITIONS ld bavel he the ight eect payment of the lan armountin more han on instalment, should debit ode or top oder clearance sie equre inerpect ‘of any amounts paid by me une the Man/Sexngs Benet teauiremert forlear repayments tom line tote excent tha for May vestments Feible Plan (Xtal: Repayments may het be mace nthe it Sess (fthe Plan Alter hentia years repayments maj ba mace at any te heute, whether inulin instalments, rouse thatthe stents meet repayment fhe loan must be made in South Aen cureney at Ol Mutuals pill pace a busines. ‘hel amount ofthe loan smaunt wl become de ana payable on heat ecuring af the allowing vers 2 "Spon any berets terms ofthe Flan/Saings Benet becoming dus and payable. 2° 1 geatnorinseneyiquideton of the/anyone ofthe Conttcting Pays of {the value ofan investment fund cortained nthe Pon/Savings Beret als below the minima iit ae by Od Mutual rom te oie ‘le Mutua sll pp the bene payabien terms ofthe Plansavinge Benefit cwsrde ztlement ofthe loan theres more than one Bonawe youl be ty and severally table othe repayment the nn [AMENDMENT TO TERMS AND CONDITIONS OF PLAN/SAVINCS BENEFIT ‘gies tothe amendment of theterms an constions of my Blan Savings Bent 2 allows No coeson |undetshe no to henate cng the Plan Ssunge Banat unite aan har bee re Nomices [Arnotices habe deme to have heen caved by you les you prove wa not Hae ‘posted toyou athe saree record for he Contacting Paty whore nthe Spears st on Oks Mutuals record n expect fhe Plan/Sa¥ngs Senet of + Sentte yeu by ematorfaxaselectes by yu in ns appkestion frm, |selct a my domettum cand et executana the physical adress prone inthe Pan'svngs Benet ‘Thsleanoprernent mili a respects be governed by and onstuadin accordance with the ls of South Acs. ‘SECTION 5 DISINVESTMENT (LIFE PURE INVESTMENT & LISP PURE INVESTMENT ONLY) 51 Ihsebyraquesta divestment subject tothe terms and conations ss therein Place Xin the apeoprate block) 152 understand that this uinvestnertissubject to the tems the Adena to my/our Satngs Berit Creel on ‘of up to 30 tracing days on te relevant sock exchangel) ato determine the toll ervertment sal by earence te the amounts esl or auch Investments oer that pend Irmo marten unde ato sndeated the ttl amount or Units inverted willbe propatonly ines Hom leur Investment Funds Os Mtua/Oms ene to ey the payment of ay timesiment othe processing of sthesifany pat hokang ase on their ena any ot thei rane: deny payment ofthe proces to them Ira rexreton placed onthe sal fasts inthe Unaring Intestine Fn, ‘hin can hapzen tom time me the same festction wil apply to your Underivng investment Fund This cen agnicany delay the processing of 54. Fora Regular Premium InvestentPlanyCommites Investment Plan Fn Amendment charge/Reduction Fee wll dete Hom the ur lus Fer {Focused Inestiner Dan a reduction fee ana Transaction Adin Fee wll be dedited tom the und vale 5. Fora Fei an tra reduction ee il be dette Hom the und vali fa esnestment made within hefrst years heen 56 wth aful/partsnvestmers the cent continues with the exiting premsum sched or adhoc investments nto te plan subject othe lowing ofthe vale ofall iestment Fuds ontared vthin the Plan/savings oer lees the amount of any outstanding lean debt fl non te miner Frnt set by Old Mutual om ime tote. he Plan!Sanngr berate canceled ths appet na value wil be pale under tha Plan's: (OLD MUTUAL INVESTMENT SERVICES PTY) LTD. 587. Myltnecontacing Pan's esatehss not been sequestvatedigudeted and 28 The Plun/Savngs Benafthaenot been ceded o pledged te aryone pre ruling onthe busines day afer the documentation received by OMS 10 Repurchase vansactone vill be ebjectto the terme and conestonsin theron Trt Osea) E82 Ther ae no resvetanton the eumbersf part/tull demestrente ‘55 With fl/pat direst the cient centinues with the easing premium schedule oad oc investment then subj fo the felling ’A lon may be terminated ithe value ol the Undarng investment Fund contained therein il below the minimum i se by OMIS rom time tote he Contractng Party sal eceve any Balance neath aftr unt ave been sa to Yecover ay charges cue © OMIS that Raven jot Been 514 (Place on-X" inthe appropriate bck) 10) DX, Par dvinvestmont selected pleats complete able Blow) Existing contact number 16660742 Eerc AMOUNT OF LOAN. From: Fund Name and amount snotunte EQUAL FROM ALL FUNDS 100.000 ot the actual endameunt of the iinestment may net be exact aqualtothe amount requested duet dl fhactuations inthe unit pie. ne funds are indieste, the total amount fun divested willbe proportionately dsinvestea fom al curent funds SECTION 4 PLAN/SAVINGS BENEFIT CANCELLATION (LIFE PURE INVESTMENT & LISP PURE INVESTMENT ONLY) ‘old Mutual Lite Assurance Company (South Africa) Limited 42 understand tha this Planing Beet cancllationnsubect tothe terms ofthe Addendum to my/our Savings Bert Crenigh ont) ing dyson the velevant ck xchange) and to deternine tho toa einer value y reference te the amounts eased for such nests vt petal Ino wermart Fund re ndcstd he total amount or uns invested val be roportonal eismested fom al current vesiment 444 Ona Regular Premium investment Plan/Corvmited nvesiment PlnFocuseed Invest mntPlan/s Plan Amendment Charge/ Reduction Fe/Transaction 145 Fora Fleible Pan (tra a reduction es wil be deducted hom th fund ale the plans encdied withun the rst 3 ys 456. lan/Savngs Benefit cencellation resin te ester Plen/Sevngs Genet easing 7” tfthe CREENLICHT Savings Benefit conelltion le slectd, the Savings Beneft premium will be cancelled. The Greenlight Risk Benet wil sti continue ‘old Mutual nvertment Services (Pty) te 158 My/the Contacting Pry’ etate has not boon sequertateiiquted and £9. Te Plan/Savnos Benet hasnt been ceded a pledges te aryone pre ring on the buses day afte the deumentstion veces ty OMS “an Repurchase transactions wl be sujet tothe terms and conten inthe rleant Trust eed. 415 Ona Committed investment PlariFocused investment Plan/a Plan Amendment Charge/Reduction FeeTransacton Admin Fe will be dedte fom {he tnd value a Recucton Fe willbe deurted fem the Fund Value SECTION 5 PAYMENT DETAILS: Diese ret my/our bank account below with he net amount Namectbank | CLA/PLI|T|EC) |B A NIK I sanen mame Blejticlviieitle Branch code 47/0 01/0 wares ue = (OLLTAT [e[S/A[U] I secomtmumber | 1/6(7| 1|/3/6|/7/4/ 7/0 Account pe ccarent [y|savras [| rarsmisson SECTION § COMMUNICATION Thereby inte! Old Mutual ile Assurance Company (Gouth Arial Lined/Old Mutual nesiment Services (Py) Lid to send me. the Contacting Party, {anfmotion ofthe seta values stole vis the communication medium inceted by malt Bele Ema wil be sed asthe preted rectum af V | ema DEB BI\EE@TBHIVCARE.ORG 16660742 L aaSECTION7 DECLARATIONS. ‘Financial Advigory and intermediary SorviesAet {Ton equet be provides wth acopy ore printed record ef thi tnscton within a easonable tie ang the fst fe (oar ote lan, a seo {era proc ol fe] yeare staring orn hee ly othe month tht you pay a premium = frist fist ofecurent rerum whieh pad a hat ate forthe hoe year il ause the etal value the premium te exceed the premiums you pad 1 irbanking dete wil eed tebe vied by my bank and Old Mutual hes the right to request such count confirmation in ing. nn addin, for ‘mounts over SO 000 Ota Hutu moyconti the deta wth me tlephorial + Thetansacion willeny be processed once Old Mua ae recaed the cnfematon serequied PROTECTION OF PERSONAL INFORMATION ACT (POPIA} NOTICE ‘Te Ole Mutua Gicup woul ike or you ongoing nancial services end may ve your personal information prvi you ith infemation about product tr serices that may be utable to met your nail needs Pease SMS you ID amber 230984 f you woul prefer net fe reetve auch information and/or \We may use your inerationor obtain oration about yuo the llowing purposes Assessment and processing ols Cre searches enor verfestn ef personal nfrmstion 1 Tracing benetieries You ay acces ou personal ntrmation tat ole array a teques uso eatery 715 fo delete his information in cen eases you have the Fahtto bject tothe pocesing of your persona rvrmation tie “nvuee gov ranoreindes hi Email Inforeg sie gona ‘view our fl pivay natce and to xeciee our preferences, ease vii our website on raweldmutualcoza ‘confirm that have rae this decoration a wall asthe loanfsinvestment terms and conditions anfunderstand the content and implications thereot ‘am eware that a Redustion Fe/Plan Amendment Charge anda Transaction Admin Fe i appllenble] maybe loved interme ofthe Plan/Savinge Benefit inthecventot loaner disinvestment. ‘For Fleible Planta, reductien fee wil be deducts ram the fund vuelta divestment made within the at's eat fhe plan ‘declare that have fll power/suthorly to apply for and enter into this transection Signed at ies! (GOODWOOD ‘on iat I Signatur of convactingpany/autharisee person Signature oftegal guardon Bao 16660742 L iSECTION 8 IDENTIFICATION (this ienntestin is ale or by Ole MuuaOM ai Commmatoner of Cats or an O14 Mutval/OMIS Fepublic of South atic, idertieaton tobe cor he fcrets of he Contracting Paty) and must be completed by 2 The Contracting Fatyiie/Athoriel Person whose nat Sted at pace ont BQ ocomutuaL sencesnoe 16660742cnt ne ante to 02848 ECan (One of the Global One money management products or services i CAPITEC Savings Account Statement & BANK Tax Invoice VAT Registration Number Capitec Bank VAT Rei Capitec Bank Limited 14/08/2020 5 Neutron Road fi 47 From Date: 15/07/2020 Techno Park Bret ear To Date: 14/08/2020 Stellenbosch Device: 9003 Print Date: 14/08/2020 7600 : Personal Details [Miss DEBORAH LONETTA ANNELINE ESAU Account Number: 1671367470 Sune STREET etuvie sourH exec TOWN $390 Posting Date Transaction Description Money in(R) Money Out (%) Balance (R) Dae zaor2020 24072620 Bankina Hop Payment Received AEsaU 200000 205460 esStatement Telkom (MRS, DEBORAH LANETTE ANNELIE ESAU 3UNIEST BELLVILLE BELLVILLE SOUTH eee ct atement date “9 deed ‘Account no 337450802 EFTRefNo 4868360005032027774 ‘Account summary Date Description Reference ‘Amount 15412020 Bence brought forward 299.00 (0Aug 2020 Payment: Thank You -R299.00 Subtotel R000 16Aug 2020 Invoice for August ‘8148308230 2303.96 Subscription usage for 0219512525 SmartVoice 100 830396 Total due R 303.96 Pram 303.96 Bank account tobe debited with R 303.96 on 05 Sep 2020 Urgent Notification Piease note that DSL services in fibre coverage areas wil be switched off on 1 September 2020, ‘To continue using your service it must be upgraded to fibre which offer greater reliably, faster internet speeds ‘and a consistently better quality service. Your fibre broadband instalation, connection and router will be FREE. Plecse urgently call 10213 Monday to Friday between Bam and 6pm and Saturday from Bom to 1pm ta upgrade. Live a connected life - work, learn, play. Ger —TELKOM DSL & FIBRE BROADBAND ne Telkom SASOC Ltd Reg office Tellom Prt, The Hub 61 Ook Avenue, Certron 0157. Comp Reg No 1991/005476/30.VAT No 4680101946. inst ST INO ine eit 149683600050320277740720000030395 Grane Sptemno Paymentcade Contalcde Ole I LI “ec8 fosa3 a2 TH on i £242 9 2021 1856 0005 032077 >>> Page 1 of &